Health care is increasingly delivered by groups of providers with diverse professional training, roles and identities. Lack of coordination and communication between health professionals may lead to adverse patient outcomes and lower patient satisfaction, risk management challenges, and provider dissatisfaction and burnout. This course provides tools to construct effective interprofessional (“IP”) teams to treat pain within models of care such as the medical home, to assess how well these teams are functioning, and to analyze and repair their dysfunction. Attendees will acquire knowledge and skills for achieving outcomes crucial to patient-centered care, focusing on pain and its treatment.

Led by seasoned IP clinician educators from occupational therapy and medicine, joined by fellow educators from the nursing and pharmacy professions, this innovative course will present methods to analyze and optimize team function. Attendees will examine how teams function as small groups, and identify how to shape cohesive functional groups.Participants will also develop skills to turn typical threats to team function from destructive forces to constructive and/or creative elements.

Pain is the most common reason for patients to seek medical care. By the conclusion of this course, participants will be able to analyze, optimize, and if circumstances require create de novo the team-based processes and policies that shape effective and efficient care of patients with pain. Applying these principles to optimize IP team management of pain will impact upon patient satisfaction, quality measures and potentially, and quality-based payment. In keeping with the PREP’s approach of training the trainers, attendees will be equipped to assume leadership roles in the assessment and treatment of pain within multiple organizational models including the medical home.

Dates & Location

·The 2014 course will take place from Thursday May 29 through July 2.

·Onsite class sessions will take place on Thursday evening, May 29 from 4-7 PM and Friday May 30 from 9AM- 5PM. [Dinner Thursday and lunch Friday plus snacks are included.]

·Online synchronous videoconferencing for case discussions and team problem-solving continue at 5:30-7:30 PM Wednesdays on June 11, June 18, June 25 and July 2.

On June 29, 2011, the Institute of Medicine (IOM) released a report addressing the issue of pain in the United States and called for “a cultural transformation in the way pain is viewed and treated” (IOM report p. 3). The 313-page report entitled: Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, examines the enormity of the burden of pain from many measures. Chronic pain affects at least 116 million U.S. adults and the financial cost of pain to society, measured in 2010 dollars, is estimated to range between $560 and $635 billion annually. In comparing these staggering numbers to other chronic diseases, the cost of pain is greater than the cost of heart disease, cancer and diabetes combined.

The authors of the IOM report base their recommendations for change and transformation of pain on nine underlying principles:

A moral imperitive

Chronic pain can be a disease in itself

Value of comprehensive treatment

Need for interdisciplinary approaches

Importance of prevention

Wider use of existing knowledge

Conundrum of opioids

Roles of patients and clinicians

Value of a public health and community-based approach

The IOM report highlights the importance of education in the multidisciplinary nature of pain issues and includes it as a key action item in the proposed blueprint for transformation of pain in our society. On the topic of professional education IOM report recommends:

Expansion and redesign of education programs to transform the understanding of pain

Improving the curriculum and education for health care professionals around the issue of pain

Increasing the number of health professionals with advanced expertise in pain care

We, at the Tufts Pain Research Education and Policy program (PREP), applaud the IOM for increasing awareness of the enormous burden of pain in our society by issuing the report: “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research“. We are also extremely proud that the Tufts PREP program has been providing the type of comprehensive pain curriculum proposed by the IOM report for over a decade, since 1999, and remains the first and only multidisciplinary postgraduate program of its kind in the United States.

Your comments and thoughts on the IOM report are welcome; please click here to read a full, unabridged online version of “Relieving Pain in America: A blueprint for Transforming Prevention, Care, Education and Research”.

Approaches to Pain Management: An Essential Guide for Clinical Leaders, published by the Joint Commission Resources, provides an overview of pain assessment and management, identifies what the standards require regarding the treatment of patients with pain, and offers guidance on making pain management an integral part of care services. Dr. Carr, an internationally recognized expert in pain management, provides both perspective and vision on the complex nature of pain.

The majority of the book is devoted to the best practices of health care institutions that have adopted focused pain programs. This updated guide also incorporates a global view of pain management, additional organizational best practices—including some from non-U.S. institutions. Other features include the following:

Summaries of every Joint Commission and Joint Commission International pain assessment and management requirement across all health care settings

Strategies for identifying and using evidence-based medicine resources for pain management

Expanded case study chapters from clinical leaders describing how their organizations developed and implemented their pain management activities

Techniques and ideas for understanding and meeting pain-related standards

Guidance on committing an organization to pain management improvements

For more information about the newly released edition of Approaches to Pain Management: An Essential Guide for Clinical Leaders, click here

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Thank you to 2010 MS-PREP alumna, Nancy Mitchell, for sending along a recent update to the Cochrane Library and the Cochrane Database of Systemic Reviews addressing acupuncture and tension-type headaches. In a previous Cochrane Review (2001), acupuncture was found to be inconclusive as a treatment for tension-type headaches. However an updated 2009 Cochrane Review on acupuncture and tension-type headaches, which included 11 randomly controlled trials, concluded that acupuncture may be a valuable treatment option for patients suffering from frequent tension-type headaches.The Cochrane Review stated: “We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or ‘fake’ acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies. In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.”
Cochrane Reviews are an integral part of evidence based medicine. It is important to include both allopathic and integrative medicine studies in the rigorous review process to further our knowledge of effective strategies to treat and manage chronic pain conditions.

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student, PREP-AIRED blog moderatorThe Mayday Fund, a leading organziation dedicated to alleviating the incidence, degree and consequence of human physical pain has announced its recommendations for high-quality, cost-effective pain care in this country as we move forward in the decade. The Mayday Fund special Committee on Pain and the Practice of Medicine has recommended 12 action steps in their report entitled: A Call to Revolutionize Chronic Pain Care in America. The committee was made up of clinicians representing nursing, medicine, pharmacy and other healthcare professionals to provide comprehensive multidisciplinary strategies to move forward in addressing this widespread public health issue. According the Mayday Fund’s report, chronic pain affects as estimated 70 million Americans making the burden of chronic pain on society greater than diabetes, heart disease and cancer combined. To read the complete report, click here

by Anne Colyn, M.Ac, MS-PREP
It seems there are several opportunites in the United Kingdom for those interested in pain research and related topics. A website for academic-based opportunities in employment, research, paid PhD studentships, etc, is currently listing quite a range of such opportunities related to pain. Birmingham City University in the UK is offering a PhD studentship in Pain Research. Deadline is coming up in just a few days (Monday, Jan 25, 2010) for an Oct 2010 start!

New England School of Acupuncture, located at 150 California St, Newton, MA, invites interested student, faculty, and community members to come to a lecture by Helene Langevin, MD, Associate Professor of Neurology, Orthopedics and Rehabilitation at the University of Vermont College of Medicine. She will speak on Monday, April 13 from 2:30-4 PM on “Connective Tissue: Relevance to Chronic Pain & Acupuncture”. Dr Langevin’s research focuses on connective tissue mechanical signal transduction as a mechanism common to acupuncture, manual and movement-based therapies. Her previous studies in humans and animal models have shown that mechanical tissue stimulation during both tissue stretch and acupuncture causes dynamic cellular responses in connective tissue. She is currently investigating how these tissue responses are affected by chronic conditions such as low back pain

by Richard Glickman-Simon, MD, Program Director, Pain Research, Education & Policy Programs, Tufts University School of Medicine
Welcome to the Programs in Pain Research, Education and Policy at Tufts University School of Medicine! Our multidisciplinary masters program is the only one of its kind in the United States, and our joint program with the New England School of Acupuncture is the only one in the world. This blog serves as a useful and engaging resource, not just for information about our program, but for timely articles on the latest developments in the field of pain and its management. Contributors include our faculty, alumni and students.
Who are we?
The mission of the Programs in Pain Research Education and Policy (PREP) is to equip our graduates with the knowledge and skills necessary to meaningfully improve the lives of people anywhere suffering from chronic or recurrent pain. Most of our students and recent graduates fall into one of two categories:
• Clinicians working with patients suffering from chronic pain (e.g., nurses, physical therapists, physicians, psychologists) who wish to be more effective on their behalf
• Students training to practice in a field that frequently serves patients in pain (e.g., acupuncture occupational therapy).
However, PREP is also well suited for those engaged in a variety of other professions including clinical research, dentistry, public health, health communication, grass-roots advocacy, legislation and the pharmaceutical industry. Recent college graduates have also enrolled in our program in preparation for medical school or other related fields.
For more information about our two masters programs and certificate program, please visit our program website.
Why do we exist?PREP was created ten years ago in response to a number of disquieting trends in the world of pain that continue to this day. Mounting research from the biomedical and social sciences clearly demonstrate that, despite their superficial similarities, acute and chronic pain share little in common. Clinicians who manage their chronic pain patients with the same methods they use for acute pain inevitably fail their patients. Acute pain results from tissue damage or other causes of inflammation as a signal to the sufferer that something is amiss and needs attention. Chronic and recurrent pain, however, often occur in the absence of any identifiably persistent cause. (See Is Pain a Disease or Symptom article in this blog.) In fact, it is hard to imagine how such pain could be construed as beneficial in any way. Simply treating chronic pain with long-standing doses of anti-inflammatory (e.g., ibuprofen), narcotic (e.g., morphine) or other analgesic medications may provide a modicum of short-term relief. However, this approach does not address the underlying problem, which is far too complex and multifaceted for any medication (or equally simplistic treatment) to manage alone.
We now know that the experience of chronic pain involves far more than the persistent transmission of noxious stimuli through the nervous system. It is the culmination of a highly elaborate and dynamic process inextricably tied to the sufferer’s cognitive, psychological, social and cultural history. Standard analgesic treatments that downplay or ignore these dimensions of suffering should not be expected to adequately serve anyone in chronic pain. A far more sophisticated approach is required if these patients are to find adequate and sustainable relief. Fortunately, this is now possible. But does it happen?
Modern medicine is quite capable of ameliorating many, if not most, acute problems, including pain. It is can also effectively manage a variety of chronic or recurrent conditions like heart disease, diabetes and peptic ulcers, largely though the use of medications and invasive procedures (e.g., surgery). It is not surprising, therefore, that most clinicians are sufficiently trained to successfully take on these common illnesses. However, for patients presenting in chronic pain, for which there is often no identifiable cause, standard methods are often not up to the task, particularly the kinds of expedient treatments emphasized in clinical training and practice. Under these circumstances, otherwise highly competent clinicians are forced to settle for symptomatic interventions that serve as stopgap measures rather than actual solutions. Many chronic pain patients, therefore, continue to suffer despite their clinician’s best efforts.
• According to data from the National Health and Nutrition Survey conducted from 1999 to 2002, 26% of Americans reported being in pain for more than 24 hours during the prior month, 42% of whom had been suffering with their pain for a year or more.
• In a 2004 survey, 27% of respondents reported low back pain, 15% reported severe headache or migraine, another 15% reported neck pain, and 4.3% reported face or temperomandibular joint (TMJ) pain in the previous three months.
• Also in 2004, 31% of adults reported joint pain (other than neck, back or TMJ) in the past 30 days; among those over 65, the proportion rose to 52%, with 17% of respondents in this age category characterizing the pain as severe.
• In 2003-04, narcotic analgesics were prescribed or provided during 23% of all emergency room visits, and for the period 1999-2002, 4.2% of adults reported using narcotic drugs in the previous month
(Data from Health, United States, 2006 from the Centers for Disease Control and Prevention)
Of course, many of these patients are benefiting from the services they receive from the physicians, nurses, physical therapist, acupuncturists and numerous other professionals providing high quality care. And, the numbers would certainly be even worse without their efforts. But what these and other troubling statistics strongly suggest is that we as a society have a long way to go before the formidable public health problem of persistent pain is brought under control.
Like any social or health problem, additional research has the potential to reduce the enormous burden of suffering from chronic pain. Even the most remarkable advances in research, however, will help no one unless they are translated into action by clinicians, educators, advocates and policymakers. It has become abundantly clear that an overly simplistic, one-dimensional strategy is no match for the complexity and tenacity of chronic pain. Pharmacologic and surgical interventions are often essential, but they are rarely sufficient. What chronic pain sufferers require is a sophisticated, multidimensional strategy worthy of the challenge.PREP was created for precisely this reason. Our programs encourage students to take on the problem of pain from every conceivable angle: biological, psychological, sociological, cultural, spiritual, ethical and legal. Our graduates emerge with an perspective and expertise few of their colleagues possess. More than anyone else, they have the capacity to meaningfully change the lives of people suffering from chronic pain.
Again, welcome. I hope you find our blog to be an interesting, provocative and enlightening gateway into the rapidly progressing and widely divergent field of pain and its management. I look forward to your comments, suggestions and contributions.

PREP stands for Pain Research, Education and Policy. We are a unique Master’s degree program drawing students from diverse fields with a common interest in creating new models for addressing and treating pain in our society. Our curriculum is based on the premise that the experience of pain and its control are influenced by factors ranging from molecules to social, cultural, and economic forces. The co-founders of this program were an anesthesiologist/internist and a sociologist, a diversity that reflects the interdisciplinary collaborative perspective of our curriculum. Our students acquire the requisite tools to understand and engage in pain research, education, and advocacy positions. We hope you will visit this blog often to see the exciting and innovative work the PREP program’s students, alumni and faculty are doing in the workd of pain research, education and policy. Visit our program website for more information.

Discussion about international collaboration between Xiaoshu Zhu (University of Western Sydney, Australia), Ewan McNichol (PREP program faculty, TUSM) and MS-PREP program graduate and acupuncturist, Kindreth Hamilton